C section - do you agree?

[ndpp]

I always wanted a vaginal birth. Due to some significant trauma in my pregnancy, mentally I did not feel able to do this and I asked for an elective c section. I was sad at this choice but felt it was best overall in the circumstances I was in. Although it was a tick box exercise to have the elective, I was surprised at the emotional pressure from nurses, doctors, HV, friends, etc to avoid a c section.

However, having had it, and a close friend desperate to have a vaginal but ended up with forceps delivery and massive tearing that two years later she’s not recovered from, I can absolutely say that the c section was easier all round. I know that’s not the case for everyone. But since then, 9/10 women I know from work and friends have all ended up with emergency c section which is of course worse than an elective.

AIBU to think that the main driver for woman to have a vaginal delivery is actually cost and not safety? I wonder if men were giving birth whether they would have comments made to pressure them into going through such trauma when actually, an ELECTIVE c section, although major surgery, is less painful for a woman and less dangerous to her.

You can't compare knowing which day you will have baby, calmly going to hospital in no pain at all and having a calm orderly operation v.... Emergency traumatic rushed Section.

@maybemaybeno I only stayed in one night, was discharged exactly 24 hours after the op and walked to the car (slowly) but I wasn't in pain.

I said at my 10 week midwife appointment and she gave me a consultant appt at 16 weeks to discuss.

Yanbu. The long term cost of pelvic floor, bladder and bowel damage is picked up by a different department. The maternity dept budget aren't paying for vaginal birth damage.

Nope. I had one planned csection (transverse baby) and four vaginal births. The csection went well and recovery went as expected but you couldn’t pay me all the money in the world to do it again. 1000x more painful and a much more prolonged recovery than my others.

I had to VB, no intervention. One at home. Both under 6 hours.

It means fuck all other than I was quite lucky. C sections can be without issue as can vaginal births.

It's not a competition.

There's so much fucking rhetoric around the process of birth.

I was exceptionally lucky.

My second birth was textbook, I didn't even push, I stood up, roared, caught my daughter as she slid out, straight on the breast.

And then, and then...

And then.

That perfect little girl. Has always been absolutely perfect.

And also has asd.

So the way you get them out is absolutely secondary.

I get it, I get being treated as a piece of meat. I understand birth trauma. But a C section either elective or emergency is a legitimate way to get a baby out. I'm glad they exist. They'd be a lot more dead women without them.

A c-section isn't necessarily less painful. The recovery can be very long and very painful. It can also be a breeze, no way to know ahead of time, just like a vaginal birth. If you know you need it, be firm and do what you need. I was in the same position with my last child, after 3 vaginal births, I knew what I could and could not do. But my request was refused and they used scare tactics to keep me from insisting. I ended up with a very traumatic emergency c-section. My baby almost died. It was one of the worst experiences of my life. Everything I said would happen did. I'm still angry about it. If I'd had the elective as I asked none of the trauma would have occurred. Women really need to be listened to and respected.

I would never choose a CS, not because I think it's a lesser option or anything, I just don't fancy being cut in half then handed a dependent. Ive had 2 VB and was up and about as normal the following day after both of them, driving, walking my dogs etc.

I'm a wimp I don't think I'd be able to handle the pain after while trying to do stuff, the labour I knew it would end fairly soon and having a baby was the only thing I had to do while in pain.

I have been quite lucky with my births though, small babies (2nd was a few weeks early), which were the right way around and no other complications

No one I know who has had a baby in the last two years has had a VB. All have been CS and all planned.

If I had known the pelvic floor and other issues following my second VB, I would have done the same. I knew I was having a big baby but it never crossed my mind to have a CS as I didn’t realise you could choose. Wish I had have known.

@maybemaybeno I was recently induced at 39 weeks and didn't require forceps and didn't hemorrhage etc. I originally wanted an ELCS but I'm glad I had a VB now. I recovered quicker than women who had c sections. I also wasn't restricted with movement and my tummy looked normal within weeks of giving birth eg flat stomach, no scars, no 'shelf' etc.

@clarebear111 a lot of mums I know have ended up with forceps, tearing (all the way up to 4th degree) and longer term issues with their pelvic floor muscles and prolapses, due to their vaginal births.

I have some issues with my pelvic floor muscles and a prolapse but this is due to pregnancy, not childbirth. I'm a few months post partum. Pregnancy was really hard on my body but childbirth wasn't that bad for me. Some women have this the other way round. I'm in my 20s and lowest end of healthy weight so most would assume I'd have less issues during pregnancy (unfortunately not).

I had a planned elective. Was very happy with my choice. Recovery was a breeze.

@MyInduction Sorry to hear about your difficult pregnancy I find it interesting that your doctors were able to confidently ascribe your prolapse and pelvic floor issues to pregnancy alone. Out of curiosity, how were they able to distinguish damage caused by pregnancy from any damage caused by your vaginal birth?

In case it's of interest, the research I have seen indicates there is a link between vaginal deliveries and pelvic organ prolapse and stress urinary incontinence, and the anecdotal information I have heard from friends and relatives seems to support this (with the caveat that it is, of course, anecdotal data). One of my DH's aunts has had 4 large babies and 4 vaginal births, and has had countless operations to try to resolve the resulting issues with her pelvic floor and prolapse, unfortunately with limited success.

Here are some links to some research papers I found helpful in case they are of interest:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681820/

https://pubmed.ncbi.nlm.nih.gov/33068134/#:~:text=Conclusion%3A%20When%20compared%20with%20vaginal,incontinence%20and%20pelvic%20organ%20prolapse.

I think all this thread shows is how terrible the NHS is at supporting physiological vaginal birth.

Birth is a natural process that our bodies can do. It’s all the messing around with the process and social conditioning that means we don’t trust the process anymore, that 9 times out of 10 is what fucks it up.

Not all birthing centre are attached to a hospital, as I said. When they are, they are just another department of the hospital, and that's exactly what they should be.

It's easy to say women have the choice before hand, but we are denying the right to change their mind.

It's outrageous that any woman in labour does not have the CHOICE to decide she needs epidural after all.

Discussion about the real risks of elective c-section and natural birth don't often exist either.

We should remove the term "elective c-section" for a start.

It only means non-emergency c-section, it doesn't mean it's a choice in most cases.

It’s so nuanced and personal for different people though.

For myself I find a birth centre attached to a hospital an unreasonable solution. I don’t want my births anywhere near theatres or doctors unless it is undeniably an emergency. I want midwife’s and myself to be given the autonomy that stand alone birth centres provide. I want to be given more time or offered more natural approaches to rectifying variations of normal. I do not want the back up of being wheeled down a corridor to feel like an easier option to staff than continuing to supporting unassisted vaginal birth if that’s what I want.

My area doesn’t offer a stand alone birth centre so I didn’t consider the one attached the hospital. My area does have a dedicated home birth team so I have my babies at home.

A women who chooses a stand alone birth centre or Homebirth for that matter is well aware that no epidural is available on site, in fact that may be part of the attraction. It does not however mean that if she changes her mind it is completely off the cards. Being blue lighted to a hospital for more pain relief is a completely reasonable solution if the women knows that this is the option available in advance and has been able to make an informed choice of her place of birth. These are choices that women are perfectly capable of making for themselves.

What isn’t acceptable is the withholding of epidurals on labour wards for women who request them which is something you hear about far too often.

I had an elective CS for my second child after being left traumatised by my experience the first time round.

I don’t regret it but I would have preferred a vaginal delivery. It is major surgery and it’s painful afterwards (especially as the NHS don’t provide proper pain relief).

I didn't say there weren't, but for me an elective c section was the least risky option, even factoring in those risks. There are plenty of risks associated with vaginal births too. You only have to glance back to the pre modern medicine era to realise how dangerous childbirth can be. We are privileged to live in the modern era where many of those dangers can be mitigated.

It's up to women to make the right decision for them, ideally an informed decision.

@stormteacupandcake *It's easy to say women have the choice before hand, but we are denying the right to change their mind.

It's outrageous that any woman in labour does not have the CHOICE to decide she needs epidural after all.*

No, this isn’t reality. Women are not denied the choice. If a women chooses to give birth at one of the very few stand alone midwife units she is making the choice to have midwife led only care unless she needs to be transferred to a hospital, just the same as if she was giving birth at home. There isn’t going to be an anaesthetist waiting at the end of your street to dish out an epidural.

If a women thinks she might change her mind she can birth at a midwife led unit attached to a hospital, which is the vast vast majority anyway. In these cases it’s incredibly straight forward to change your mind and swap to the labour ward for an epidural.

The women who choose to give birth at a stand alone midwife led unit do so for specific reasons and anaesthetists, doctors and surgeons on hand undermines what they actually want, which is a non medical environment.

I've had both and recovered from the vaginal birth much more quickly than the c-section.

Depends on the hospital and doctors.

With my first, they pushed induction unnecessarily, scared me into it and baby was em-cs and blue, caused brain damage that we didn’t realise until years later. He will likely never live independently. Traumatised and still feel sometimes I should have been brave enough to stand my ground, especially when DS1 is having meltdowns bad enough to start hitting us and struggling to cope with the environment around him.

Second (same hospital but it’s the only hospital that had the means to take care of baby if things went sideways) was a v-bac but baby needed to be turned. I was given a choice (forceps or em-cs) and told what the risks were but they didn’t tell me that an episiotomy would be done and found that out after and the recovery was harder. Could barely walk half a block five days later, carrying around a doughnut to sit on, and lost enough blood to need iron transfusions. Baby was happy and healthy and a much better experience than my first.

Third time, different hospital and chose an elective cs due to baby. She was head down but was moving in and out of positions that could make vaginal birth risky to both of us and I didn’t want to end up with episiotomy, tearing or em-cs with two school-aged children at home and the bedroom being on the second floor (live in a townhouse). All but one doctor supported my decision and I really didn’t care what his opinion was, it was not worth the risk of waiting til I go into labour being already overdue for a vaginal delivery and hoping for the best.

It was a quick, relaxed, very pleasant and positive experience. I was on my own due to it being half term, DH had the kids. Everyone introduced themselves, able to have my own music, baby placed on my chest for skin to skin, nursed her, and placed on the ward. I’m happy with my decision, baby is healthy, and I’m healing up nicely.

My two attempts to evict large-ish, back to back babies through spontaneous labour ended up with an EMCS after two hours of pushing, and a rough forceps birth in theatre at the pushing stage as it was a close call on rough forceps vs rough EMCS.

I'd come from a family of relatively straightforward births and felt cheated by the EMCS after the long labour. There were complications of labour that put me in HDU, and it was 3 weeks before I felt stable enough walking to carry DS on the stairs. The odds of a VBAC were favourable and the professionals keen.

I still didn't drive for 4 weeks after because it was too painful sitting on the tear. It also aggravated my SPD and my mobility was impaired for 4 months afterwards.

On paper with both births the NHS would happily let me have another "sucessful VBAC" 50:50 with acknowledging the severity of tearing and not argue against a ELCS.

Vaginal birth is a lottery.
ELCSs chosen without critical medical complications tend to go fairly smoothly.
From the anecdotes of the many women I know who've had inductions, I think there is a lot of scope to improve that process and intervene with well managed EMCSs before mothers and babies struggle from the impact of taking days to progress. The better inductions I've known of have been from late gestation with history of spontaneous labour. Triggering early labour frequently results in a traumatic process.

I'd also say from my own experience that non-critical complications like SPD are not well considered. First pregnancy, I had "pregnancy aches and pains" when I reached the point of being unable to walk around the supermarket again after 34 weeks and ended up near housebound (this was also ignored on the postnatal wards) It's very much the luck of the draw on having a MW who is prepared to take reasonable measures on helping to get comfortable in an instinctive birthing position, especially if monitoring is involved.

Personalisation of antenatal care and labour can be very poor and often treated as tickboxing which can then cause issues in subsequent pregnancies/ births.

The NHS tends to be pretty brilliant at saving lives, but it is not the greatest at joined up holistic thinking and preventing further issues. It very much has a culture of balancing the budget in this department now, not long term efficiency.

Who cares if you need your pelvic floor reconstructing in 2050 if it costs more to avoid in 2023?

I was 14 days "overdue" and had a natural drug-free home birth despite immense pressure from OBGYN. No gas and air, first baby. As far as I can tell most women go over, to the point that its like the docs under estimate by two weeks as standard or something.

I honestly don't believe your body will grow a baby you can't handle birthing size wise. There may be other factors that lead to intervention but its a rare thing to actually have a baby thats literally too big. Mine was over 9lb and I had her at home with no drugs or intervention.
Modern medicine has taken away our trust in our own bodies abilities.

C section comes with risks of various common but low severity longer term health risks to the baby but minimises the risk of catastrophic outcomes - the ones which cost the NHS billions in terms of permanent life changing disability.

Crudely speaking it takes the most sever risks of VB away from the baby and transfers them to the mother and to her subsequent pregnancies.